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Dr. Peter Zalan: To protect the North, it’s time to close the roads to all but essential traffic

‘We are at a crisis point. There is truly no time to lose’
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Monday, March 30, the Globe and Mail’s front page read: Nine seniors dead. 

It happened at Pinecrest Nursing Home in a small community 150 km northeast of Toronto. It all started in mid-March with mild chest symptoms. Four patients were ill on a Tuesday; eight were ill on Wednesday. By Thursday, it was 12 and by Friday, 23. Three have tested positive for COVID-19. All nine are presumed to have died of the virus. 

Seventeen members of the staff have tested positive and 34 have symptoms. They are now working with a skeleton staff.

Is there anything we can do to prevent such a bleak future for all of us?

As a retired intensive care physician, I understand the tyranny of time. For the brain, we have five minutes to restore oxygen supply before the onset of irreversible damage. For the heart, we have three hours to restore blood supply to a blocked artery. In cases of septic shock, delay in injecting life-saving antibiotics decreases the chance of recovery moment by moment.

China, Taiwan and Korea just saw a recent jump in cases, all due to citizens returning from outside the country. In our country, we are experiencing the return of huge numbers of Canadians across our borders. An unknown number will be infected with COVID-19.

Is this the calm before the storm in the North? Do we still have the opportunity, if we adopt the correct measures, to prevent disaster? Parts of our huge country without large clusters of cases may still be able to avoid the worst of the outbreak.

The Quebec government announced on March 28 that it is moving immediately to protect some of the province’s more remote regions from the spread of COVID-19 by setting up checkpoints to block non-essential travel. If people attempting to enter or leave the regions are not providing an essential service, if they are not going for health reasons or for humanitarian reasons, they will be sent home.

This public health order applies primarily to eastern and northern Quebec.

Quebec provincial police have also set up checkpoints near the Canada-U.S. border to intercept snowbirds coming back to Quebec to ensure they understand there’s a 14-day quarantine in place.
The province has identified parts of Montreal and the Eastern Townships as hotspots for the spread of the virus.

Exactly the point that holds true elsewhere.

Ontario's COVID-19 cases jumped to 1,706 on March 30, the largest single-day increase yet. This, plus the seven new deaths at Pinecrest Nursing Home.

In sharp contrast, Northern Ontario, so far, has had relatively few documented cases of COVID-19. There are no patients admitted to Health Sciences North with a confirmed infection (at the time Zalan wrote this, there were none; now there is one). No deaths to date.

Containment of the virus is losing its usefulness in the south. New infections are increasing at an alarming rate. Our northern hospitals are working hard to get ready for the expected surge in admissions. This is a sensible precaution. Yet there is still hope for containment in Northern Ontario, still hope to avoid the horrors of Italy.

In the North, we need to test, test, test so we can identify infected persons. That requires greater testing capacity. That will happen, but not immediately.

We need to amass sufficient equipment to protect our health-care providers. That will happen but not immediately.

We need to minimize the number of infected people entering our communities. That we can do immediately.

Because of our relative isolation over a huge landmass, our northern communities have the chance to avoid what happened in Italy and what is starting to affect our big cities down south. We must stop travel between southern Ontario and Northern Ontario, except for essential commercial traffic.

Like Quebec just did.

We have little time to act. The virus is extremely contagious. The rate of spread at Pinecrest is the new reality.

I hate to think what will happen if the virus gets into isolated and remote Indigenous communities, into small, geographically remote towns and into nursing homes.

We are at a crisis point. There is truly no time to lose. 

Mr. Ford, please act immediately.

This action is equally relevant to most of our other provinces and territories. Canada is an endless land of magnificent forests, rivers, lakes and mountains, interrupted here and there by the cities that are the hotspots for spread of the virus.
 
Dr. Peter Zalan is past president of the medical staff at Health Sciences North.




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